In the 1970s and 1980s elkhorn coral, Acropora palmata, declined dramatically throughout the Caribbean primarily due to white-band disease (WBD). In 2005, elkhorn coral was proposed for listing as threatened under the US Endangered Species Act. WBD was first documented at Buck Island Reef National Monument (BIRNM). Together with hurricanes WBD reduced live elkhorn coral coverage by probably over 90%. In the past decade some recovery has been observed at BIRNM. This study assessed the distribution and abundance of elkhorn coral and estimated the prevalence of WBD at the monument. Within an area of 795 ha, we estimated 97,232-134,371 (95% confidence limits) elkhorn coral colonies with any dimension of connected live tissue greater than one meter, about 3% of which were infected by WBD. Despite some recovery, the elkhorn coral density remains low and WBD may continue to present a threat to the elkhorn coral population. ?? Springer-Verlag 2006.